Background:Carbapenem-resistant gram-negative bacterial (CRGNB) pneumonia is a severe clinical challenge. This study aimed to assess the efficacy and safety of nebulized polymyxin B sulfate for its treatment. Methods:A multicenter, prospective, observational study was conducted in seven hospitals in Zhejiang Province, China, from January to October 2022. Patients diagnosed with CRGNB pneumonia and treated with nebulized polymyxin B sulfate were included. Data on baseline characteristics, microbiology, adverse events, and clinical outcomes were collected. The primary endpoint was the pathogen eradication rate 14 days after discontinuation of inhalation therapy. Secondary endpoints included microbial alternation, incidence of bronchospasm, and 28-day and 60-day mortality rates. Results:A total of 91 patients with CRGNB pneumonia received nebulized polymyxin B sulfate. The duration of inhalation ranged from 7 to 15 days, with a median of 9 days. Concurrent intravenous polymyxin B was administered in 72.5% of patients. Among 87 patients with available microbiological data, pathogen eradication was achieved in 33 cases (37.9%) and presumed eradication in 30 cases (34.5%), resulting in a total eradication rate of 72.4%. Persistent CRGNB infection was observed in 24 patients (27.6%). Microbial alternation occurred in 26 patients (29.9%), mainly involving intrinsically polymyxin B-resistant species such as Burkholderia and Serratia spp., and 4 polymyxin B-resistant CRGNB strains (1 case of Acinetobacter baumannii, 2 cases of Klebsiella pneumoniae, and 1 case of Pseudomonas aeruginosa). The incidence of bronchospasm was 3.3% (3/91), all of which were relieved with inhaled corticosteroids and short-acting β2 agonists without discontinuation of inhalation therapy. The 28-day and 60-day mortality rates were 18.7% and 28.6%, respectively. Conclusion:Nebulized polymyxin B sulfate achieved a high pathogen eradication rate, low microbial alternation, and good airway tolerability in patients with CRGNB pneumonia; supporting its efficacy and safety as a therapeutic option.

BACKGROUND:Sepsis, a dysregulated host response to infection, frequently leads to catastrophic intestinal barrier failure, a key driver of mortality. Magnolol, a bioactive compound from Magnolia officinalis, has shown pleiotropic therapeutic effects, but its role in sepsis-induced intestinal injury remains unclear. Here, we investigate the protective mechanisms of magnolol in sepsis, focusing on its modulation of inflammatory signaling. METHODS:We employed both in vitro (LPS-stimulated Caco-2 cells) and in vivo (cecal ligation and puncture model of sepsis) systems. The effects of magnolol on cellular viability, apoptosis, inflammatory cytokine production, and intestinal barrier integrity were assessed using a combination of molecular and histological techniques, including Western blot, immunofluorescence, ChIP, and Co-IP assays. RESULTS:Magnolol potently mitigated LPS- and sepsis-induced cellular damage, apoptosis, and inflammation, while preserving intestinal barrier function. Mechanistically, we identify magnolol as a direct transcriptional activator of peroxisome proliferator-activated receptor gamma (PPARG). Magnolol treatment robustly reversed the LPS-mediated suppression of PPARG transcriptional activity (P < 0.001). This activation was crucial for its protective effects, as CRISPR-Cas9-mediated knockdown of PPARG abrogated magnolol's benefits. Furthermore, magnolol restored the physical interaction between PPARG and its co-activator p300/CBP, which was disrupted by LPS. Crucially, activation of PPARG by magnolol led to the dual inhibition of the pro-inflammatory JAK-STAT and NF-κB signaling pathways. CONCLUSION:Our study delineates a novel protective mechanism for magnolol in sepsis, demonstrating that it functions as a potent PPARG agonist to suppress the inflammatory cascade driven by the JAK-STAT and NF-κB pathways. These findings establish magnolol as a promising, mechanistically defined therapeutic candidate for treating sepsis-induced intestinal injury.

Aims: The present work aimed to examine impact of tanshinone IIA on intestinal barrier in sepsis and to explore the underpinning mechanisms. Materials and Methods: Sepsis induction in Sprague-Dawley (SD) rats was conducted via cecal ligation and puncture (CLP), with subsequent intraperitoneal injection of tanshinone IIA. Intestinal permeability was examined 12 h post-operation using the fluorescein isothiocyanate dextran method. Blood and distal ileum tissue samples were collected for Enzyme-Linked Immunosorbent Assay (ELISA) analysis of oxidative stress and inflammatory markers. Histopathologic examination was performed using hematoxylin and eosin staining and the Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Immunofluorescence and immunoblot were performed for protein detection. In vitro, Caco-2 cells were administered lipopolysaccharide (LPS) followed by tanshinone IIA treatment, and pregnane X receptor (PXR) and cytochrome P450-3A4 (CYP3A4) protein levels were assessed. Results: In sepsis model rats, tanshinone IIA dose-dependently reversed the increased intestinal permeability, bacterial shift rate, ileum Chiu's score, apoptosis level of ileal mucosa, the elevated serum and ileal Malondialdehyde (MDA), Interleukin-1 beta (IL-1β), and Tumor Necrosis Factor-alpha (TNF-α) amounts, and the enhanced ileal expression levels of Proto-oncogene c-Fos (c-Fos) and tryptase proteins. In addition, tanshinone IIA restored the decreased serum and ileal Superoxide Dismutase (SOD) levels and reversed the reduced ileal expression levels of claudin-1, Junctional Adhesion Molecule (JAM), occludin, and ZO-1. In vitro, tanshinone IIA restored PXR and CYP3A4 levels following LPS stimulation. Conclusion: Tanshinone IIA exerts a protective effect in murine CLP-induced sepsis. The underlying mechanism may involve activation of the PXR-CYP3A4 pathway in murine intestinal epithelial cells.

Metabolic dysfunction-associated steatotic liver disease(MASLD),formerly known as nonalcoholic fatty liver disease,is a chronic liver disease characterized by hepatic lipid deposition and hepatocellular steatosis,resulting from nonalcoholic causes and closely linked to metabolic dysfunction[1].

ETHNOPHARMACOLOGICAL RELEVANCE:Enhanced apoptosis of intestinal epithelial cells during sepsis results in impaired barrier function, facilitating the influx of bacteria and endotoxins into the bloodstream, which worsens the organism's damage. Therefore, addressing intestinal injury in sepsis may represent a novel approach to treatment. Shenling Baizhu Powder (SLBZP), a classical traditional Chinese medicine formula, has been widely used for the treatment of Inflammatory diseases including sepsis. However, its potential mechanisms of action in sepsis-induced intestinal injury remain unclear. AIM OF THE STUDY:This study aimed to investigate whether SLBZP and its betulin ameliorate intestinal barrier function and cellular death in sepsis mice and LPS-induced IEC-6 cells through GADD45B/TAOK1/p38 MAPK pathway. MATERIALS AND METHODS:Network pharmacology and Gene Expression Omnibus (GEO) database were used to identify the potential active ingredients and epigenetic regulators of SLBZP. High-performance liquid chromatography coupled with mass spectrometry (HPLC/MS) was used to measure the betulin present in SLBZP. Besides, the animal model of sepsis was developed by using a cecal ligation and puncture (CLP) to investigate the protective roles of SLBZP and betulin on intestinal injury in sepsis. Furthermore, the determination of cell viability, inflammation, and apoptosis of LPS-induced IEC-6 cells treated by betulin was performed by Cell counting Kit-8 (CCK-8), ELISA, Tunel staining, and flow cytometry assays. Meanwhile, the underlying mechanism was investigated through IHC, qMSP, and Western blot assays, respectively. RESULTS:Through network and GSE202261 analysis, three epigenetic regulators including GADD45B, MAP3K7, and PRKAA1 were screened from the "drug-component-target" network. The betulin and the GADD45B had a good binding ability in molecular docking. Animal experiments indicated that SLBZP and betulin could inhibit inflammation, ameliorate intestinal injury, and reduce cell apoptosis in mice. Moreover, the intestinal cytotoxicity of LPS-treated IEC-6 cells was significantly inhibited after betulin treatment, as accompanied by an increase in DNA methylation level in the TAOK1 promoter. Importantly, we found that the overexpression of GADD45B and TAOK1, or p38 MAPK inhibitor reversed the anti-apoptosis effect induced by the betulin. CONCLUSIONS:SLBZP and betulin may exert anti-inflammatory and anti-apoptosis effects against sepsis-associated intestinal barrier injury, possibly via the GADD45B/TAOK1/p38 MAPK pathway.

As immunotherapy gains increasing attention and clinical application, the immune modulation therapy has been widely used in the treatment of infectious and critical diseases. Clinical evidence has been accumulated for application of thymosin alpha 1 (T alpha 1), a classical immune modulator, in related domains. The National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases and other institutions invited multidisciplinary experts to develop this expert consensus on clinical application of T alpha 1 in infectious diseases and critical care medicine. Based on the latest domestic and international research findings and considering relevant factors, including economics, patient preferences and values, tradeoffs, accessibility, fairness and acceptability, the consensus assesses the quality levels of current evidence and forms 10 recommendations on the application of T alpha 1 in treatment of liver diseases, viral infections, bacterial infections and critical illnesses. This consensus aims to enhance understanding of T alpha 1 and improving its standardized application for clinicians.

Background Catheter-related candidemia (CRC) is a serious catheter-related bloodstream infection (CRBSI) caused by Candida spp., with higher mortality than CRBSIs caused by other organisms. ObjectiveTo identify the risk factors for Candida CRBSI. The clinical characteristics of 297 patients with CRBSI in a local hospital from January 2007 to June 2015 were collected, including 33 Candida CRBSI and 264 non-Candida CRBSI. Method The associations of Candida CRBSI with the clinical variables were examined using univariate and multivariate analyses. Results Multivariate analysis showed that glucocorticoid use (odds ratio [OR] = 10.313, 95% confidence interval [CI] = 2.032-52.330, P = 0.005) and parenteral nutrition (OR = 5.400, 95% CI = 0.472-61.752, P = 0.0175) were independent risk factors for Candida CRBSI. The most prevalent species were Candida tropicalis (42.4%) and Candida albicans (36.36%). Of the 33 Candida CRBSI cases, 31 (93.93%) had indwelling central venous catheters (CVC) for >= 14 d. The mortality of Candida CRBSI was remarkably higher than that of bacteria CRBSI. Patients with timely catheter removal and appropriate antifungal treatment had dramatically increased 28-d survival compared with those with untimely catheter removal + inappropriate antifungal treatment (88.89% vs. 0, P = 0.006). Conclusion The study identified glucocorticoid use and parenteral nutrition as independent risk factors for Candida CRBSI. The outcome of candidemia was associated with the duration of CVC indwelling and antifungal treatment.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation of the colon. Tanshinone IIA, a compound derived from traditional Chinese medicine, has demonstrated anti-inflammatory properties and may enhance treatment outcomes when combined with mesalazine. This study aims to determine the overall response rate of Tanshinone IIA in combination with mesalazine for the treatment of UC. We reviewed articles from the establishment of the databases until April 2023 in the PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM databases. They included a randomized controlled trial in which the intervention group was given tanshinone IIA plus mesalazine (T + M), while the comparative group was given only mesalazine (M). We removed duplicates or similar papers; papers with no available full text or incomplete data; animal research; and review and systematic review articles. STATA 15.1 was used to analyze the data. The perceived total effectiveness rate of T + M was found to be higher than M and the difference was found to be significant (P = 0.000). Additionally, pooled results show that TNF-α (P = 0.000) and CRP (P = 0.000) levels in the T + M group were all significantly lower than that in the M group. Furthermore, MHC-II expression in the T + M group was minors compared to that of the M group (P = 0.001). However, there was no significant difference in the incidence of adverse events between the T + M and M groups (P = 0.700). This meta-analysis demonstrates that combining tanshinone IIA with mesalazine significantly enhances the overall treatment efficacy for ulcerative colitis compared to mesalazine alone. Tanshinone IIA also exhibits anti-inflammatory effects by reducing TNF-α, CRP levels, and MHC-II expression without notably increasing adverse events. Despite some limitations, these findings suggest that tanshinone IIA can be a promising adjunctive therapy for ulcerative colitis. Further large-scale, multi-center studies are needed to confirm these results and establish the long-term safety and effectiveness of this combination therapy.

Acute gastrointestinal injury (AGI) is common in mechanically ventilated (MV) patients, but the potential association between ventilatory pressure parameters and AGI grade and their impact on mortality remains unclear. This study aimed to explore the association between ventilatory pressure parameters and AGI grade, and their interaction on all-cause mortality in MV patients. This study was a secondary analysis of a multicenter, prospective, observational study that enrolled adult patients with an expected duration of mechanical ventilation >= 48 h from 14 general intensive care units in Zhejiang Province between March and August 2014. The AGI grade was assessed daily on the basis of gastrointestinal symptoms, intra-abdominal pressures, and feeding intolerance in the first week of admission to the ICU. This study included 331 patients (69.2% men; mean age, 64.618.9 years). Multivariate regression analysis showed that plateau pressure (Pplat) (OR1.044, 95% CI 1.009-1.081, P=0.013), serum creatinine (OR1.003, 95% CI 1.001-1.006, P=0.042) and APACHE II score (OR1.035, 95% CI 1.021-1.072, P=0.045) were independently associated with global AGI grade III/IV within 7 days of ICU admission. Moreover, global AGI grade (HR2.228, 95% CI 1.561-3.182, P<0.001), serum creatinine (HR1.002, 95% CI 1.001-1.003, P=0.012) and APACHE II score (HR1.039, 95% CI 1.015-1.063, P=0.001) were independently associated with 60-day mortality. In addition, there were significant (P-int <= 0.028) interactions of Pplat and DP with AGI grade in relation to 60-days mortality, whereas no interaction (P-int=0.061) between PEEP and AGI grade on 60-days mortality was observed. In the presence of Pplat >= 19 cmH(2)O, the patients with AGI grade III/IV had 60-day mortality rate of 72.2%, significantly higher than those with AGI grade I/II (48.7%, P=0.018), whereas there were no significant differences (27.9% vs. 33.7%, P=0.39) in 60-days mortality between AGI grade I/II and III/IV among the patients with Pplat<19 cmH(2)O. In comparison with Pplat, DP had a similar interaction (P-int=0.028) with AGI grade on 60-day mortality. Ventilatory pressure parameters (Pplat and DP) are independent risk factors of AGI grade III/IV. Pplat and DP interact with AGI grade on 60-days mortality, highlighting the importance of optimizing ventilatory pressure parameters to improve gastrointestinal function and survival outcomes of MV patients.

BACKGROUND:The prognosis of critically ill patients is closely linked to their gastrointestinal (GI) function. The acute GI injury (AGI) grading system, established in 2012, is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings. In 2021, the GI dysfunction score (GIDS) was developed, building on the AGI grading system, to enhance the accuracy of GI dysfunction severity assessment, improve prognostic predictions, reduce subjectivity, and increase reproducibility. AIM:To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients. METHODS:A retrospective study was conducted at the general intensive care unit (ICU) of a regional university hospital. All data were collected during the first week of ICU admission. The primary outcome was 28-day mortality. Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality. The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve, with DeLong's test assessing differences between the curves' areas. RESULTS:The incidence of AGI in the first week of ICU admission was 92.13%. There were 85 deaths (47.75%) within 28 days of ICU admission. There was no initial 24-hour difference in GIDS between the non-survival and survival groups. Both GIDS (OR 2.01, 95%CI: 1.25-3.24; P = 0.004) and AGI grade (OR 1.94, 95%CI: 1.12-3.38; P = 0.019) were independent predictors of 28-day mortality. No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission (Z = -0.26, P = 0.794). CONCLUSION:GIDS within the first 24 hours was an unreliable predictor of 28-day mortality. The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

Severe acute pancreatitis(SAP)is a serious systemic disease as-sociated with strong local inflammatory reactions and serious sys-temic pathophysiological disorders caused by trypsin spillover.Pa-tients with SAP are prone to exhibit gastrointestinal dysfunction.Meanwhile,gastrointestinal dysfunction further aggravates the sys-temic inflammatory response and metabolic abnormalities,result-ing in a more critical condition of SAP.Gastrointestinal dysfunction is considered to be the"trigger"of multiple organ dysfunction syn-drome[1].Thus,it is important to maintain gastrointestinal home-ostasis in the treatment of SAP.

Endothelial dysfunction is associated with the progression of sepsis. This study sought to probe the molecular route of sex-determining region on the Y chromosome-box transcription factor 18 (SOX18) in sepsis-associated endothelial injury. Human umbilical vein endothelial cells (HUVECs) were treated with lipopolysaccharide (LPS) to establish the sepsis cell model. Cell viability, lactate dehydrogenase (LDH) release, oxidative stress (reactive oxygen species/malondialdehyde/superoxide dismutase), and inflammation (interleukin-1β/tumor necrosis factor-α/interleukin-6) were evaluated by cell counting kit-8 assay and relevant assay kits. The expression levels of SOX18, microRNA (miR)-204-5p, and cadherin-2 (CDH2) in cells were determined by real-time quantitative polymerase chain reaction and Western blot assay. The interaction of SOX18, miR-204-5p, and CDH2 was analyzed by chromatin immunoprecipitation and dual-luciferase assay. LPS induced HUVECs injury and downregulation of SOX18. SOX18 overexpression increased cell viability, while decreased LDH activity, oxidative stress, and inflammation. SOX18 bound to the miR-204-5p promoter to promote miR-204-5p expression, and further repressed CDH2 expression. miR-204-5p knockdown and CDH2 overexpression abrogated the protective role of SOX18 in HUVECs injury. Overall, SOX18 alleviated LPS-induced injury of HUVECs by promoting miR-204-5p and repressing CDH2, suggesting it as a potential target for sepsis treatment.

Severe acute pancreatitis（SAP） is a common and critical disease. It is life-threatening at any time if multiple organ dysfunction occurs. SAP may develop secondary infection, often iatrogenic [1]. To treat infected SAP, appropriate antibiotic use and nosocomial management is critical, along with adequate drainage of the infected foci and optimizing the immune function. Not only is the use of powerful antibiotics necessary to minimize mortality,

OBJECTIVE To observe the protective effect of forsythiaside A on acute lung injury (ALI) in septic rats. METHODS Male Sprague-Dawley (SD) rats were randomly divided into normal control group, sham operation group, sepsis model group, and forsythiaside A intervention group, with 10 rats in each group. The rats in the normal control group did not receive any intervention; the rats in the sham operation group only underwent abdominal surgery; and those in the model group and forsythiaside A intervention group received cecal ligation and puncture (CLP) to establish the sepsis rat model. The rats in the forsythiaside A intervention group were given 75 mL/kg of forsythiaside A within 0.5 hour after operation, and repeated after 6 hours. The rats in the sham operation group and model group were given the same amount of normal saline at the same time points. The lung tissues were collected for pathological examination 12 hours after operation. The lung homogenate was prepared, and enzyme-linked immunosorbent assay (ELISA) was used to detect tumor necrosis factor-α (TNF-α), interleukins (IL-1β, IL-6). The activity of superoxide dismutase (SOD) was detected by xanthine oxidase method, and the content of malonaldehyde (MDA) was detected by colorimetry. The expression of nuclear factor-κB p65 (NF-κB p65) was detected by Western blotting. RESULTS There was no significant pathological change of lung tissue in both normal control group and sham operation group, and there was no significant difference in each parameter between the two groups. The rats in the model group had interstitial infiltration of inflammatory cells, alveolar structure destruction, alveolar septum thicken, extensive alveolar hemorrhage, telangiectasia; the levels of TNF-α, IL-1β, IL-6, MDA and NF-κB p65 protein expression in lung tissue were significantly higher than those in the normal control group and sham operation group [TNF-α (ng/L): 132.81±16.15 vs. 45.08±5.98, 46.10±6.72, IL-1β (ng/L): 137.32±15.22 vs. 51.03±7.89, 50.92±8.13; IL-6 (ng/L): 138.39±14.28 vs. 51.68±7.03, 52.48±7.36; MDA (kU/g): 1.79±0.13 vs. 0.96±0.05, 0.97±0.05; NF-κB p65 protein (NF-κB p65/GAPDH): 2.82±0.23 vs. 1.76±0.12, 1.82±0.13; all P < 0.05], the activity of SOD decreased significantly (kU/g: 45.90±5.46 vs. 92.11±10.13, 93.36±10.56, both P < 0.05). The changes in lung histopathology in the forsythiaside A intervention group were obviously improved as compared with the model group, which showed less inflammatory cell infiltration, less alveolar septum thickening, less bleeding and more intact structures; the levels of TNF-α, IL-1β, IL-6, MDA and the expression of NF-κB p65 protein in lung tissue were significantly lower than those in the model group [TNF-α (ng/L): 72.48±9.78 vs. 132.81±16.15, IL-1β (ng/L): 83.85±12.46 vs. 137.32±15.22, IL-6 (ng/L): 81.88±11.89 vs. 138.39±14.28, MDA (kU/L): 1.29±0.09 vs. 1.79±0.13, NF-κB p65 protein (NF-κB p65/GAPDH): 2.29±0.19 vs. 2.82±0.23, all P < 0.05], SOD activity increased significantly (kU/g: 66.03±7.98 vs. 45.90±5.46, P < 0.05). CONCLUSIONS Forsythiaside A can effectively alleviate ALI in septic rats. The mechanism may be related to down-regulate the expression of NF-κB p65 and reduce the level of inflammatory factors and free radicals in lung tissue, thereby against acute lung injury in septic rats.

OBJECTIVE:To evaluate whether electroacupuncture (EA) would improve gastrointestinal function and clinical prognosis in patients with severe traumatic brain injury (TBI) complicocted by acute gastrointestinal injury (AGI).METHODS:This multicenter, single-blind trial included patients with TBI and AGI admitted to 5 Chinese hospitals from September 2018 to December 2019. A total of 500 patients were randomized to the control or acupuncture groups using a random number table, 250 cases in each group. Patients in the control group received conventional treatment, including mannitol, nutritional support, epilepsy and infection prevention, and maintenance of water, electrolytes, and acid-base balance. While patients in the acupuncture group received EA intervention at bilateral Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25), and Zhongwan (RN 12) acupoints in addition to the conventional treatment, 30 min per time, twice daily, for 7 d. The primary endpoint was 28-d mortality. The secondary endpoints were serum levels of D-lactic acid (D-lac), diamine oxidase (DAO), lipopolysaccharide (LPS), motilin (MTL) and gastrin (GAS), intra-abdominal pressure (IAP), bowel sounds, abdominal circumference, AGI grade, scores of gastrointestinal failure (GIF), Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction Syndrome (MODS), mechanical ventilation time, intense care unit (ICU) stay, and the incidence of hospital-acquired pneumonia.RESULTS:The 28-d mortality in the acupuncture group was lower than that in the control group (22.80% vs. 33.20%, P<0.05). Compared with the control group, the acupuncture group at 7 d showed lower GIF, APACHE II, SOFA, MODS scores, D-lac, DAO, LPS, IAP, and abdominal circumference and higher GCS score, MTL, GAS, and bowel sound frequency (all P<0.05). In addition, the above indices showed simillar changes at 7 d compared with days 1 and 3 (all P<0.05) in the EA group.CONCLUSION:Early EA can improve gastrointestinal function and clinical prognosis in patients with severe TBI complicated by AGI. (Registration No. ChiCTR2000032276).

目的 分析浙江省温岭市2010至2020年副溶血弧菌大流行株感染性腹泻的流行病学状况.方法 选取2010-2020年浙江省温岭市食源性疾病检测哨点医院就诊,并报告至国家食源性疾病监测系统的急性腹泻患者900例,根据肠道细菌培养结果统计副溶血弧菌大流行株感染的检出率,分析其危险因素及主要血清型构成分布情况.结果 900例急性腹泻患者中有500例检测出副溶血弧菌大流行株,检出率为55.56％,其血清型主要为O3:K6(占45.45％～85.11％).单因素分析显示:副溶血弧菌大流行株感染性急性腹泻与性别、职业类型、家庭月收入无关(P>0.05),而与年龄、食品暴露史、厨房抹布平均更换频率、单独餐具、洗手方式、是否使用家用带盖垃圾桶、是否为公共厨房、患病季节有关(P<0.05).多因素Logistics回归分析显示:年龄、食品暴露史、厨房抹布平均更换频率、单独餐具、洗手方式、是否使用家用带盖垃圾桶、是否为公共厨房、患病季节为影响副溶血弧菌大流行株感染性急性腹泻的主要危险因素(P<0.05).结论 副溶血弧菌大流行株感染是急性腹泻的主要病原微生物,其主要血清型为O3:K6,其发生与卫生习惯、卫生环境有关.可根据这些因素采用相应的预防措施,以减少副溶血弧菌大流行株感染性急性腹泻的发生.

目的:系统评价糖尿病专用配方和标准肠内营养制剂对重症病人高血糖在糖代谢、胰岛素用量及营养等指标方面的影响.方法:检索PubMed、Embase、Web of Science、Cochrane、Scopus、中国知网(CNKI)、万方等数据库中和研究相关的随机对照研究,以平均血糖水平、空腹血糖、餐后2h血糖、每日胰岛素用量、血清白蛋白、前白蛋白及28 d死亡率为结局指标.结果 应用Review Manager 5.4完成统计分析.结果 :糖尿病专用配方对比标准肠内营养制剂在平均血糖水平、空腹血糖、餐后2h血糖及每日胰岛素用量方面差异有统计学意义;在血清白蛋白、前白蛋白和28 d死亡率方面无统计学差异.结论:糖尿病专用配方在控制重症病人血糖及减少胰岛素用量方面较标准肠内营养制剂更有优势.

BACKGROUND:Sepsis is a major medical challenge. Magnolol is an active constituent of Houpu that improves tissue function and exerts strong anti-endotoxin and anti-inflammatory effects, but the mechanism by which it reduces intestinal inflammation in sepsis is yet unclear.AIM:To assess the protective effect of magnolol on intestinal mucosal epithelial cells in sepsis and elucidate the underlying mechanisms.METHODS:Enzyme-linked immunosorbent assay was used to measure tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and regulated on activation, normal T-cell expressed and secreted (RANTES) levels in serum and ileal tissue in animal studies. The histopathological changes of the ileal mucosa in different groups were observed under a microscope. Cell Counting Kit-8 and cell permeability assays were used to determine the concentration of drug-containing serum that did not affect the activity of Caco2 cells but inhibited lipopolysaccharide (LPS)-induced decrease in permeability. Immunofluorescence and Western blot assays were used to detect the levels of RANTES, inhibitor of nuclear factor kappa-B kinase β (IKKβ), phosphorylated IKKβ (p-IKKβ), inhibitor of nuclear factor kappa-B kinase α (IκBα), p65, and p-p65 proteins in different groups in vitro.RESULTS:In rats treated with LPS by intravenous tail injection in the presence or absence of magnolol, magnolol inhibited the expression of proinflammatory cytokines, IL-1β, IL-6, and TNF-α in a dose-dependent manner. In addition, magnolol suppressed the production of RANTES in LPS-stimulated sepsis rats. Moreover, in vitro studies suggested that magnolol inhibited the increase of p65 nucleation, thereby markedly downregulating the production of the phosphorylated form of IKKβ in LPS-treated Caco2 cells. Specifically, magnolol inhibited the translocation of the transcription factor nuclear factor-kappa B (NF-κB) from the cytosol into the nucleus and down-regulated the expression level of the chemokine RANTES in LPS-stimulated Caco2 cells.CONCLUSION:Magnolol down-regulates RANTES levels by inhibiting the LPS/NF-κB signaling pathways, thereby suppressing IL-1β, IL-6, and TNF-α expression to alleviate the mucosal barrier dysfunction in sepsis.

OBJECTIVE: To evaluate the therapeutic effect of electroacupuncture on acute gastrointestinal injury (AGI) in patients with severe traumatic brain injury (sTBI). METHODS: A prospective randomized controlled trial was conducted. 126 consecutively hospitalized patients with AGI after sTBI admitted to intensive care unit (ICU) of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2018 to December 2019 were enrolled. The patients were divided into observation group and control group by random number table. All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days, including the treatments of primary diseases, indwelling nasogastric tube to extract gastric contents every 6 hours to determine gastric residual volume (GRV). When vital signs were basically stable, enteral nutrition (EN) was implemented and EN feeding amount and speed were adjusted according to GRV. On the basis of conventional western medicine treatment, the observation group was treated with electroacupuncture at Zusanli, Tianshu, Shangjuxu, Xiajuxu and Zhongwan, once in the morning and once in the evening, 30 minutes each time. The gastrointestinal function parameters including intra-abdominal pressure (IAP), serum diamine oxidase (DAO) and gastrointestinal failure (GIF) scores were observed before treatment and at day 3 and day 7 of treatment. The incidence of ICU hospital-acquired pneumonia (HAP-ICU), duration of mechanical ventilation (MV), length of ICU stay, 28-day mortality and adverse reactions of electroacupuncture were also observed in the two groups. Kaplan-Meier method was used for 28-day survival analysis. RESULTS: During the 7-day treatment and observation, 26 cases of 126 patients withdrew from the study, and 100 cases were actually enrolled, 50 cases in the observation group and 50 cases in the control group. IAP and DAO at day 3 of treatment in both groups were significantly lower than those before treatment [control group: IAP (cmH2O, 1 cmH2O = 0.098 kPa) was 13.75±2.76 vs. 18.11±3.97, DAO (U/L) was 129.88±24.81 vs. 158.01±22.64; observation group: IAP (cmH2O) was 13.56±2.19 vs. 18.50±3.54, DAO (U/L) was 129.11±29.32 vs. 159.36±28.65; all P < 0.01]. The gastrointestinal function parameters of the two groups improved gradually with the extension of treatment time, and the IAP, DAO and GIF scores at day 7 of treatment in the observation group were significantly lower than those in the control group [IAP (cmH2O): 11.28±3.61 vs. 12.68±3.23, DAO (U/L): 49.69±17.56 vs. 57.27±20.15, GIF score: 2.02±0.74 vs. 2.40±0.70, all P < 0.05). The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group [duration of MV (days): 15.72±4.60 vs. 18.08±4.54, length of ICU stay (days): 16.76±4.68 vs. 19.26±5.42, both P < 0.05], and the incidence of ICU-HAP and 28-day mortality were significantly lowered (12.0% vs. 30.0%, 22.0% vs. 32.0%, both P < 0.05). Survival analysis showed that the 28-day cumulative survival rate in the observation group was significantly higher than that in the control group (86.4% vs. 76.1%; Log-Rank test: χ2 = 37.954, P < 0.001). The patients in the observation group had no significant adverse reaction of electroacupuncture treatment. CONCLUSIONS: Electroacupuncture at corresponding acupoints can effectively improve gastrointestinal function in patients with AGI after sTBI, which is beneficial to shortening the length of ICU stay, promoting the recovery of the patients, and reducing the 28-day mortality.

Intestinal microecology is an important part of human internal environment and is an extremely complex ecosystem consisting of gut microbiota, intestinal mucosa and intestinal immune sys- tem [1] . Gut is highly specialized for the digestion and absorption of different nutrients. The gut microbiota is the largest and most complex, which not only affects the local function of the intestine, but also plays an important role in the maturation and mainte- nance of the whole immune system.